Biventricular Reverse Remodeling After Percutaneous Pulmonary Valve Implantation With a Self-Expandable Pulsta Valve in Native Right Ventricular Outflow Tract

Background: The effects of percutaneous pulmonary valve implantation (PPVI) on biventricular remodeling, ventricular interaction, and effective right ventricular (RV) forward flow in native RV outflow tract disease remain incompletely characterized. Methods and Results: We retrospectively evaluated 84 patients (46 male) who underwent PPVI with a self-expandable Pulsta valve (median age at PPVI 25.0 years) with paired cardiac magnetic resonance imaging and 1-year echocardiographic follow-up. Ventricular volumes, pulmonary regurgitation fraction, effective RV stroke volume, left ventricular (LV) filling indices, echocardiographic parameters, and cardiopulmonary exercise test results were compared before and after PPVI. The pulmonary regurgitation fraction decreased from 40.0% to 7.7%, with reductions in the RV end-diastolic volume index from 167.7 to 123.5 mL/m 2 and the RV end-systolic volume index from 88.3 to 65.3 mL/m 2 (all P<0.001). RV ejection fraction remained unchanged. Effective RV stroke volume increased from 73.5 to 83.7 mL, LV end-diastolic volume index increased from 77.2 to 84.5 mL/m 2 , and LV stroke volume increased from 72.4 to 80.4 mL (all P<0.001). Peak oxygen consumption improved from 25.8 to 27.8 mL/kg/min (P=0.025). Changes in the LV end-diastolic volume index were inversely correlated with changes in the RV end-diastolic volume index and RV end-systolic volume indices. Conclusions: PPVI with a self-expandable Pulsta valve improved RV unloading, effective RV forward flow, LV filling, and exercise capacity despite an unchanged RV ejection fraction.